Provider Demographics
NPI:1780995464
Name:GAEFKE, B. ELLEN (CPM)
Entity type:Individual
Prefix:
First Name:B.
Middle Name:ELLEN
Last Name:GAEFKE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:EIGHTY FOUR
Mailing Address - State:PA
Mailing Address - Zip Code:15330-2109
Mailing Address - Country:US
Mailing Address - Phone:724-229-7218
Mailing Address - Fax:724-229-7452
Practice Address - Street 1:47 EMERY RD
Practice Address - Street 2:
Practice Address - City:EIGHTY FOUR
Practice Address - State:PA
Practice Address - Zip Code:15330-2109
Practice Address - Country:US
Practice Address - Phone:724-229-7218
Practice Address - Fax:724-229-7452
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
97030020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife